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INAUGURAL  DISSERTATION 

O  N 

DYSENTERY. 


SUBMITTED  TO  THB  PUBLIC  EXAMINATION 
OP    THE 

FACULTY    OF    PHYSIC, 

UNDER    THE    AUTHORITY    OF     THE 

TRUSTEES  OF  COLUMBIA  COLLEGE, 

IN      THE 

STATE  OF  NEW-YORK, 

WILLIAM  SAMUEL  JOHNSON,  LL.  D,   Prefident; 

FOR  The  degree  of 

DOCTOR    OF     PHYSIC, 

ON  THE  SIXTH  DAY  OF  MAY,    1794. 


By    DAVID     G.     A  B  E  E  L, 

Citizen  of  the  State  of  New-York, 


The  Hp  pale,  quivering)  and  the  beamlefs  eye, 
No  more  with  ardour  bright.— — 

Thomson. 


NEir-YORK: 

Printed   by  T.  and  J.  Swords,  Printers  to  the  Faculty  of  Phyfic  of 

Columbia  College,  No.  167,  "William-Street. 

— 1794.—^ 


,^^y9^ 


4i-  -. ^<^^*^'--^ 


r  o 


ISAAC  ROOSEVELT,  Prefident, 

MOSES  ROGERS,  Treafurer, 

JOHN  H.  LIVINGSTON,  D.  D.^ 
JOHN  RODGERS,  D.  D. 
ABRAHAM  BEACH,  D.  D. 
JOHN  BROOME, 
JOHN  SLOSS  HOBART, 
SAMUEL  OSGOOD,  ., 

JOHN  WATTS, 
MATTHEW  CLARKSON, 
JOHN  COZINE, 
LAWRENCE  EMBREE, 


Managers  of  the 
/  City  Difpenfaiy. 


JOHN  CHARLTON,  Prefident, 

and 
THOMAS  JONES,  Vice-Prefident, 


I 


Of  the  Medical  Society 
of  the  State  of  Newr 
York,  and  ex-officio 
Managers  of  the  City 
Difpenfary. 


THIS 

DISSERTATION 

Is  refpedfully  infcribed, 
By  their  mofl  obedient, 
Humble  fervant, 


DAVID  G.  ABEEL. 


^ 


■■     .      .0        ■"  .      „    „  I      .1        ''■=£= 


BISSERTATION 


ON 


DYSENTERY. 


D 


YSENTERY  is  a  difeafe  to  which  Phyficians  have 
only  of  late  years  annexed  precife  and  accurate  ideas. 
Every  increafed  difcharge  from  the  inteftinal  canal,  of  a 
paorbid  nature,  and  particularly  if  accompanied  with 
fome  mixture  of  blood,  was  formerly  confidered  by  Phy- 
ficians as  Dyfentery.  Hippocrates  himfelf  feems  to  have 
confounded  the  terms  Dyfenteria,  Diarrhoea  and  Lienteria, 
and  to  have  applied  them  rather  to  exprefs  particular  ftages 
of  the  fame  complaint,  than  to  have  viewed  them  as  dif- 
tinft  and  different  difeafes.* 

About  the  middle  of  the  prefent  century,  when  Phy- 
licians  and  Philofophers  became  ufefully  engaged  in  invef- 

tig^ating 

*  Vide  Hipp.  Op,  Epld.  et  Apb. 


(    6    ) 

tigating  the  caufes  of  difeafes,  with  a  view  to  their  more 
effedual  prevention  and  fuccefsful  cure,  the  caufes  of 
dyfentery  were  with  more  accuracy  afcertained,  as  being 
produced  by  a  fpecific  contagion.  Sir  John  Pringle  is 
among  the  firfl  whofe  obferyations  have  tended  to  enlarge 
our  ideas  on  the  nature  of  this  complaint. 

Dyfentery,  as  defcribed  by  the  moft  refpe6lable  writers 
in  medicine,*  is  a  difeafe  which  appears  to  be  of  only 
one  fpecies;  and  though  it  is  fometimes  accompanied 
with  intermittent  fever,  with  miliary  eruptions,  and  is 
often  attended  with  difcharges  of  worms  and  other  matters 
from  the  inteftinal  canal;  yet  thefe  circumftances  can, 
only  produce  varieties  of  the  fame  difeafe. 

■  I)o<^or  GuLLEN  has  accurately  defined  dyfentery  by 
the  following  charai^eriftic  fymptoms. 

"  Pyrexia  contagiofa,  deje<5Vione8  fre^uentes,  mmoi^Sf 
vel  fanguinolentae,  retentis  plerumque  fcecibus  akipis; 
tormina,  tenefmus."f  -  a~:;ijxi 


*  See  Sydenham,  fe£l.  iv.  chap,  3.  Huxam  de  Acre,  &c.  ad.  ann. 
1743.  Cleghorn''s  Difeafe  of  Minorca,  chap.  5.  Pringle's  Difeafe  of  the 
Army.  Monro's  Difeafe  of  the  Army,  1761,  Zimmerman  en  the 
Dyfentery,  1765. 


f  Culleni  Synopfis  Nofologras  Metbodlcae. 


HISTORY 


(    7    ) 


HISTORY  OF  THE  DISEASE. 

DYSENTERY  is  commonly  preceded  by  a  fenfe  of 
coldnefs,  more  or  lefs  laflitude,  and  pains  of  the  head, 
back  and  loins,  which  are  afterwards  followed  by  increaf- 
ed  heat — Thefe  fymptoms  are  fucceeded  by  pains  in  the 
bowels,  about  the  region  of  the  naval,  which  have  been 
called  by  the  Latins  tormina — Thefe  pains  are  accom- 
panied with  a  defire  of  evacuating  the  contents  of  the 
intellines;  which  is  fometimes  effected,  attended  with 
difcharges  of  mucus  and  more  or  lefs  blood.  After  ^ 
few  llools,  the  difcharge  becomes  liquid  and  of  a  yellow- 
er brown  colour,  with  mucus,  and  fometimes  pure  blood. 
The  foeces  are  then  difcharged  in  nodes  or  hard  lumps^ 
called  by  authors  fcybala,  the  freeing  the  intellines  from 
which  commonly  gives  relief. 

When  the  fymptoms  firfl  come  on,  they  are  often  at- 
tended with  naufea  and  vomiting,  when  a  matter  of  a 
green  colour,  and  of  a  bilious  nature,  is  ejected.  The 
patient  complains  of  great  thirft  and  a  difagreeable  bitter 
tafte.  The  tongue  is  commonly  covered  with  a  whitifh 
or  yellow  fcurfj  fometimes  it  is  brown,  and  in  fome  cafes 
black.  The  patiant  has  feldom  any  appetite  for  food, 
and  ufually  complains  of  great  proflration  of  ftrength. 
In  fome  inftances  the  patient  is  very  coftive  in  the  be* 
ginning  of  the  difeafe,-  and  the  abdomen  is  fwelled  in 
confequence  of  its  being  diilended  with  wind.    As  the 

difeafe 


(    s    ) 

difeafe  increafeSj  the  patient  is  affe6led  with  more  fre- 
quent defires  of  evacuating  the  contents  of  the  intef- 
tines,  but  withotit  producing  that  effeS:.  Subflances  of 
a  firm  and  compa6t  texture,  refembling  pieces  of  cheefe 
or  fat,  and  even  parts  of  the  villous  coat  of  the  inteftines, 
are  fometimes  difcharged.  There  is  alfo  a  fluid,  in  ap- 
pearance like  pus,  at  times  evacuated.  Unlefs  purgative 
medicines  are  adrriiniftered,  it  is  rare  that  excrementitioud 
matters  are  thrown  out  of  the  inteftines. 

The  efforts  to  evacuate  the  contents  bf  the  inteftineg. 
are  accompanied  with  tormina,  tenefmus,  and  much  pain; 
the  patient  having  a  fenfation  as  if  the  inteftines  were 
tomprefted  and  cut.  Painful  haemorrhoidal  tumours  are 
apt  to  take  place  in  thofe  who  have  been  previoufty  af- 
fected with  them.  A  prolapfus  ani  is  alfo  frequently- 
produced,  efpecially  in  young  perfons.  The  urine  i^ 
often  difcharged  with  pain^  difficulty,  and  a  fenfe  of 
heat.  Food  taken  into  the  ftomach  is  frequently  ejected, 
without  having  fufFered  much  change  from  the  organs 
of  digeftioh;  and  in  fome  cafes  the  a6l  of  deglutition 
has  been  followed  by  griping  pains  and  tenefmus.  The 
pulfe  is  frequent,  but,  except  in  thofe  who  are  very  ro- 
buft,  rarely  hard  or  ftrong. 

The  dyfenteric  and  febrile  fymptoms  are  commonly 
increafed  towards  evening,  but  remit  fomewhat  towards 
morning.  Before  this  difeafe  proves  fatal,  all  the  fymptoms 
become  more  fevere.  The  tormina  and  deje(5lions  are  fo 
frequent  that  the  patient  has  fcarcely  any  intermiffion  of 

pain. 


(     9     ) 

pain.  What,  is  difcharged  from  the  intefllnes  is  of  a 
very  foetid  nature,  and  frequently  involuntary.  The  pulfe, 
during  this  ftage,  is  fmall  and  frequent;  the  tongue  is  black 
and  dry ;  the  thirft  very  great,  and  every  fymptom  of  debi- 
lity manifefls  itfelf;  fuch  as  hiccough,  cold  fweats,  pale- 
nefs  of  the  fac,e,  coldnefs  of  the  extremities,  difficult  de- 
glutition, and,  laftly,  aphthae  in  the  mouth  and  fauces, 
fwelling  of  the  abdomen,  involuntary  difcharge  of  foeces 
and  urine,  delerium,  and  a  cefTation  of  pain,  are  the  fore- 
runners of  death.  With  the  above  defcribed  fymptoms,  in 
part  or  in  concurrence,  the  difeafe  continues  an  uncertain 
length  of  time.  When  the  complaint  is  mild,  itfometimes 
terminates  in  four  or  five  days:  when  more  fevere,  not 
til-i  fourteen  or  fifteen  days,  and  fometimes  even  later. 

When  the  dyfentery  is  of  a  mild  kind,  the  fymptoms 
of  tormina,  tenefmus,  and  alvine  excretions  are  lefs  fre- 
quent j  the  excretions  more  natural,  lefs  mixed  with 
blood  or  mucus,  and  not  of  fo  difagreeable  a  fmell; 
the  appetite,  for  food  is  llronger,  there  is  lefs  thirft,  and 
the  patient  has  more  refrefliing  fleep. 

In  this  difeafe,  the  pains  which,  in  the  beginning,  oc- 
cupied the  whole  abdomen,  feem,  in  its  advanced  ftate,  to 
be  more  circumfcribed,  and  to  be  confined  to  the  infe- 
rior part  of  the  colon  and  beginning  of  the  redum. 
When  the  pains  are  very  fevere,  it  commonly  happens 
that  the  fmall  inteftines  are  alfo  affe6led,  as  there  are  a 
greater  number  of  nerves  diftributed  among  them. 

B  As 


(     lo     > 

As  dyfenteries  ufually  appear  in  the  beginning  of  au* 
tumn,  the  fever  which  attends  them  commonly  puts  on  a 
fynochus  or  typhus  form:  fometimes,  however,  they 
are  combined  with  an  intermittent  or  remittent  fever. 
Dyfenteries  have  aifo  fometimes  appeared  in  the  fpring. 
and  fummer,  and  then  have  had  fome  connection  with  the 
difeafes  which  ufually  prevail  at  thofe  feafons  of  the  year. 


DISSECTIONS. 

O  N  examining  the  bodies  of  thofe  who  have  died  of 
dyfentery,  the  inferior  parts  of  the  colon  and  re6lum  have 
been  found  of  a  black  colour,  and  of  a  putrid  appearance; 
their  coats  preternatu rally  thickened,  and  the  internal  parts 
ulcerated.  Red  puftule^,  refembling  thofe  of  the  fmall-pox, 
have  been  found  in  the  inner  coats  of  the  inteftines.* 
Schirrous  tumors  have  alfo  been  difcovered  fometimes  in  the 
colon.  In  almofl  all  cafes  in  which  gangrene  had  not  taken 
place  to  any  great  degree,  ccnliderable  portions  of  the  large 
inteftines  have  been  found  affefted  with  a  preternatural 
confLri(?tion.'f- 


DIAGNOSIS. 

THE  difeafes  which  may  be  miftaken  for  dyfentery  are 
dianficea  and  cholera:  but  a  little  attention  will  enable  the 
Phyfician  to  eftablifa  the  proper  diagnofis. 

In 

*  P-ilngle's  Difeafes  of  the  Army,  p.  246. 

f  CiiUen's  Firll  Liriss,  vol.  ii.  p. 294.  par.  1077* 


In  diarrhoea  there  Is  no  idiopathic  fever,  the  tormina  and 
tenefmus  are  lefs  violent,  and  the  difcharges  from  the  intef- 
tines  are  more  natural.  In  dyfentery  the  flools  are  more 
putrid,  and  mixed  with  more  b)ood  than  is  commonly 
obferved  in  diarrhcsa. 

Dyfentery  is  diilinguiflied  from  cholera  by  lefs  copiou^ 
bilious  vomitings.  In  cholera  the  ftools  are  large,  and 
mixed  with  confiderable  quantities  of  bile,  but  rarely  any 
blood;  ther^  is  no  tenefmus,  and  the  fpafms  of  the  mufcles 
of  the  legs,  which  are  chara6leriftic  of  cholera,  rarely  take 
place  in  dyfentery.  It  mull  alfo  be  obferved,  that  dyfentery 
is  a  contagious  difeafe,  and  may  be  diftingulfhed  from  other 
com.plaints  by  its  prevailing  as  an  epidemic. 


CAUSES. 

THESE  may  be  divided  into  Remote  and  Proximate. 


REMOTE  CAUSES. 

THE  remote  caufes  may  be  divided  into  two  kinds: 

I.  Such  as  predifpofe  perfons  to  this  difeafe;  or, 

a.  Such  as  occafion  or  bring  on  the  difeafe  in  thofe  who 

are  already  predifpofed. 
The  firft  are  called  predifponent;  the  fecond,  occalional 
or  exciting  caufes — Thefe  are  now  to  be  defcribed. 

PREDISPONENT 


(  12  ) 


PREDISPONENT  CAUSES. 

PREDISPOSITION,  according  to  Doaor  Brown,  is 
that  ilate  of  the  body  not  fufficiently  difordered  to  produce 
difeafe;  but,  by  verging  towards  it,  renders  a  perfon  fufcep- 
tible  of  the  operation  of  the  occafional  or  exciting  caufe.^ 
This  ftate  may  be  brought  on  by  all  thofe  caufes  which 
induce  debility  of  the  whole  fyftem,  and  efpecialiy  of  the 
alimentary  canal. 

The  caufes  which  debilitate  the  whole  fyflem  are  ufually 
too  great  fatigue,  and  deprefling  paffions  of  the  mind. 
Thefe  alfo  affe6l  the  ftomach  and  inteftines,  and  are 
known  to  have  frequently  interrupted  digeftion,  and  to 
have  induced  iicknefs,  naufea,  and  vomiting. 

Intoxication  alfo  debilitates  the  fyftem.  Small  quanti- 
ties of  fpirituous  liquors  are  known  to  exhilarate  the  fpi- 
rits,  and  to  give  vigour  to  the  fyftem :  but  when  taken  in 
too  great  quantities,  or  often  repeated,  they  diminifh  the 
nervous  power,  and  bring  on  fymptoms  of  debility. 

The  fummer  heat,  by  debilitating  the  body,  alfo  predif- 
pofes  to  this  complaint :  hence  foldiers,  who  have  been 
much  expofed  and  aftively  employed  in  the  fum.mer,  are 
ufuajly  taken  with  this  difeafe  towards  autumn. 

Cold, 

^  Brown's  Elements  of  Medicine. 


(     '3     ) 

Cold,  applied  to  the  body,  efpecially  at  night  or  during 
fleep,  may  be  confidered  as  the  mofl  frequent  predifpdnent 
caufe  of  this  difeafe. 

In  warm  climates,  and  in  this  country  in  autumn,  it 
is  very  common  for  us  to  obferve  coniiderable  viciflitudes 
of  heat  and  cold  in  the  fpace  of  twenty-four  hours.  A 
fmall  change  in  the  thermometer  produces  a  great  eifed  on 
the  body,  when  warm  or  previoufly  heated:  hence  cold, 
applied  to  the  body,  appears  to  have  different  efFeds: 

1.  By  debilitating  the  body,  it  predifpofes  to  favour  the 
operation  of  contagion. 

2.  By  interrupting  the  determination  to  the  furface,  it 
eaufes  a  greater  determination  to  the  inteflines;  and, 

3-  By  preventing  the  excretions  of  the  various  noxious 
humours  from  the  body,  contributes  to  favour  putrefcence 
in  the  fyftem. 

When  we  confider  thefe  different  effects  of  cold  in  pre^ 
difpofing  the  fyflem  to  the  attack  of  this  difeafe,  we  may 
readily  conceive  the  reafons  which  have  induced  many 
Phyficians  to  fuppofe  cold  to  be  the  occafional  or  exciting 
caufe  of  dyfentery.  When  we  refleft  that  cold,  applied 
to  the  body  in  the  winter,  under  certain  circumftances,  is 
the  caufe  of  catarrh,  and  many  other  difeafes  affeding 
the  thorax,  it  may  have  a  greater  agency  in  producing 
dyfentery  than  is  at  prefent  imagined.     Cold,  applied  to 

the 


(     H    ) 

ihe  feet,  is  known  to  affed  the  inteftines,  infomuch  that 
it  is  often  prefcribed  to  obviate  great  degrees  of  conflipa- 
tion.  Cold  is  known  to  be  the  exciting  caufe  of  diarrhoea, 
and  perhaps  is  more  powerful  in  producing  dyfentery,  than 
acting  as  a  predifponent  caufe  only. 

Moiflure,  combined  with  heat  and  cold,  renders  the 
morbid  operation  of  each  the  more  powerful;  and  hence 
it  may  be  conlidered  as  concurring  with  thefe  in  eireding 
a  predifpofition  to  dyfentery. 

In  the  latter  part  of  fummer  or  beginning  of  autumn, 
there  is  much  moiflure  in  the  atmofphere,  in  confequence 
of  the  fummer  heat :  it  is  then  that  people  are  much  dif- 
pofed  to  contraft  dyfenteries,  efpecially  in  fleets  and  ar- 
mies, where  the  foldiers  and  failors  are  much  expofed  to 
the  viciffitudes  of  heat  and  cold,  from  the  peculiar  fitua- 
tion  in  which  they  are  placed. 

Previous  difeafes,  by  weakening  the  fyftem  and  derang- 
ing the  different  funftions,  predifpofe  the  body  alfo  to  the 
operation  of  every  kind  of  contagion,  and  efpecially  to 
that  which  produces  dyfentery. 

Thefe,  and  other  caufes  which  debilitate  the  fyflem, 
have  a  manifefl  etfed  in  favouring  the  operation  of  the 
occafional  or  exciting  caufe  of  dyfentery,  which  we  come 
next  to  confider. 


OCCASIONAL 


(    H    ) 


OCCASIONAL  OR  EXCITING  CAUSE. 

AN  occafional  or  exciting  caufe  is  only  a  poUible 
caufe,  and  does  not  produce  its  effeds  unlefs  under  certain 
circumftances.  What  thefe  circumllances  are,  I  fhall  not 
pretend  pofitively  to  deterrnine ;  but  they  feem  to  be  thofe 
which  are  marked  as  conftituting  a  predifpofition. 

The  celebrated  Do£tor  Cullen,  after  attending  to  the 
nature  of  dyfentery,  fays,  that  "  the  difeafe  is  always  con- 
tagious, and  by  the  propagating  of  fuch  contagion,  inde- 
pendent of  cold  or  other  exciting  caufes,  it  becomes  epi- 
demic in  camps  and  other  places.  It  is  therefore  to  be 
doubted,  if  the  application  of  cold  does  ever  produce  the 
difeafe,  unlefs  when  the  fpecific  contagion  has  been  previ- 
oufly  received  into  the  body;  and,  upon  the  whole,  it  is 
probable,  that  a  fpecific  contagion  is  to  be  confidered  as 
always  the  remote  caufe  of  this  difeafe."* 

But  what  the  nature  of  the  contagion  is  that  produces 
dyfentery,  does  not  feem  to  be  perfectly  underftood;  nor 
is  it  more  evident  what  are  the  fources  of  its  produftion. 

As  dyfenteries  are  commonly  combined  with  fynochus 
and  typhus,  and  fometimes  with  intermittent  and  remit- 
tent fevers,  it  may  be  doubted  whether  the  fever  accom- 
panying dyfenteries  does  not  arife  from  the  fame  caufes 
which  produce  thofe  complaints,  namely,  marfh  or  human 

effluvia ; 
*  CuUen's  Firft  Lines,  par.  1075. 


(     i6    ) 

eflPiuvIa;  and  whether  the  local  afFe(5lion  of  the  inteftines  is 
not  owing  to  a  morbid  determination  to  thefe  parts,  in 
confequence  of  the  operation  of  cold  or  other  caufes.* 
It  is,  however,  certain,  that  fome  fpecies  of  contagion 
feem  to  affe6l  certain  parts  of  the  body  in  a  peculiar  man- 
ner. Thus,  the  ikin  is  afFe6ted  in  the  fmall-pox  and  mea- 
fles,  the  throat  in  the  cynanche  maligna,  the  lungs  in  the 
pertuffis,  and  the  membrana  fneideriana  in  the  influenza: 
fo  it  may  be,  that  a  contagion  of  a  fpecific  nature  may 
afFed  the  inteftines  in  preference  to  any  other  part,  though 
we  are  unacquainted  with  its  nature  or  the  mode  of  its  pro- 
duftion. 

The  opinion  that  the  febrile  fymptoms  which  attend  dy* 
fenteries  do  not  conftitute  an  original  fever,  or  one  peculiar 
to  that  difeafe,  feems  probable  from  this  circumftance,  that 
fometimes  the  fever  is  of  an  intermittent  form,  fometimes 
of  a  remittent,  and  at  others  of  afynochus  or  typhus  nature. 
We  do  not  find  thefe  various  kinds  of  fever  in  fcarlatina^ 
meafles,  fmall-pox,  and  other  difeafes  which  arife  from  a 
fpecific  contagion.  It  has  been  fuppofed  by  fome  Phyli- 
cians,  that  dyfenteries  are  not  produced  from  contagion  :f 
this  error  has  arifen  from  its  being  confounded  with  diarr- 
hoea; and  perhaps  thofe  cafes  of  dyfentery  which  are 
mentioned  by  Do<5lor  Cleghorn,|  Sir  John  Pringle,§ 
and  others,  to  be  combined  with  intermittent  and  remittent 
fevers,  have  only  been  cafes  of  diarrhoea  inftead  of  dyfentery. 

Thofe. 

*  Doftor  Romayne's  M,  S,  Leftures,  1791, 
■f  Mofeley  on  Tropical  Difeafes,  21 1» 
X  Difeafe  of  Minorca. 
§  Difeafes  of  the  Army, 


(     17     ) 

Thofe  who  are  but  little  acquainted  with  the  writings  of 
inany  modem  Phyficians,  will  readily  difcover,  that  the 
hiflory  of  dyfentery  is  differently  flated  by  moft  of  them; 
and  that  this  difference  can  only  be  fettled  by  future  obfer- 
vationso 


PROXIMATE  CAUSE. 

BY  an  attention  to  the  feries  of  fymptoms  which  ufually 
attend  dyfenteries,  it  is  manifefl,  that  a  confiderable  part 
of  their  proximate  eaufe  is  conne6led  with  a  febrile 
difeafe,  and  that  this  mufl  depend  on  the  fame  circum- 
flances  as  the  proximate  caufe  of  fevers  in  general,  which 
Do6lor  CuLLEN  fuppofes  to  depend  upon  an  atony  and 
fpafm  of  the  extreme  vefTels.  There  is  no  doubt  but  that 
the  fymptoms  of  dyfentery  point  out  a  diminifhed  energy 
of  the  nervous  fyflem  and  a  tendency  to  putrefcence, 
Thefe  are  marked  in  the  languor,  laflitude,  Hate  of  the 
tongue,  flomach,  and  the  various  functions  of  the 
body.  But  there  are  another  feries  of  fymptoms  M^hich 
are  peculiar  to  dyfenteries,  and  upon  which  their  prox- 
imate caufe  more  immediately  depends.  Thefe  have  been 
variouOy  coniidered  by  Phyficians. 

Doftor  CuLLEN  is  of  opinion  ^'  that  the  proximate 
caufe  of  dyfentery,  or  at  leaft  the  chief  part  of  the  proxi- 
mate caufe,  confifts  in  a  preternatural  conflri6tion  of  the 
coloD)  occafioning  at  the  fame  time,  thofe  fpafmodic  ef- 
forts which  are  felt  in  fevere  gripings,  and  which  efforts, 
C  propagated 


(     iS    ) 

propagated  downwards,  occafiorx  there  the  frequent  mucous 
ilools  and  tenefmus."^ 

It  is  certain,  that  many  of  the  fymptoms  which  are 
chara6teriftic  of  dyfentery,  are  beft  explained  upon  thefe 
principles;  fuch  as  the  formation  of  the  fcybala,  and  their 
retention  in  the  inteflines,  notwithftanding  the  efforts  to 
have  them  ejefted.  The  mucous  commonly  difcharged  in 
this  difeafe  is  owing  to  an  abrafion  of  the  internal  coats  of 
the  inteftines,  which  are  generally  covered  with  it  in  confi- 
derable  quantities;  and  it  is  not  improbable  but  that  in  this 
difeafe,  there  is  a  morbid  fecretion  of  it.  The  appearance 
of  the  blood  with  the  mucous  maybe  readily  explained, 
from  a  i-upture  of  fome  of  the  fmaller  blood- veffels,  and 
perhaps  from  a  dilatation  of  their  mouths.  The  latter  of 
thefe  Sir  John  Pringle  fuppofes  frequently  to  happen. 
He  likewife  obferves,  that  "  flreaks  of  blood''  appearing 
among  the  matter  voided,  "  denote  the  opening  of  fome 
of  the  fmall  veffels  at  the  end  of  the  reftum,  but  a  more 
intimate  mixture  is  a  lign  that  the  blood  comes  from  *i 
higher  fource."f 

-  Some  have  fuppofed  the  proximate  caufe  of  dyfentery  to 
depend  upon  inflammation ;t  but  inflammation  is  racher 
the  natural  efied  of  much  fpafmodic  effort,  than  the  caufe. 
Hence  we  may  confider  inflammation,  and  its  confe- 
quences,  ulceration  and  gangrene,  to  be  more  the  effe<5ls  of 
fpafm  than  the  caufe  of  it. 

Others 

*  Flrfl  Lines,  vol.  ii-  par.  1078. 

'[  Pringie''s  Difeafes  of  the  Army,  p.  2z8. 

%  Anderas  Mitchel's  Inaug.  Diilsrt.  dc  Dyfenterla,  Edinb.  17S93 


(     ^9    ) 

Others  have  fuppofed  a  redundancy  of  bile,  and  an 
increafed  acrimony  of  it,  to  be  the  caufe  of  dyfentery;* 
but,  if  much  bile  be  generated  in  the  courfe  of  dyfenteries, 
it  appears  to  be  an  efFe6l  of  the  operation  of  fome  of  the 
remote  caufes.  A  morbid  fecretion,  and  perhaps  an  acri- 
mony of  the  bile,  may  occafion  cholera  and  diarrhoea;  but 
I  cannot  fuppofe  that  it  can  produce  dyfentery. 

Many  have  imputed  the  immediate  caufe  of  dyfentery 
to  the  eating  a  great  quantity  of  fruit;  but  this  is  a  vulgar 
error.  From  obfervations  now  made,  it  is  manifeft  that 
fruits  have  no  effe£t  in  producing  this  difeafe;  and  ripe 
fruits  are  among  the  belt  remedies  to  obviate  the  complaint. 
It  is  a  remark  made  by  authors  in  general,  that  dyfenteries 
appear  more  prevalent  in  thofe  years  in  which  there  is  leaft 
fruit.f  From  this  it  would  appear,  that  they  have  rather 
9.  tendency  to  prevent  the  coming  on  of  the  difeafe. 

Worms  have  likewife  been  fuppofed  to  produce  this 
complaint,  which  is  alfo  a  vulgar  error.  Living  ahi- 
malculae  have  been  fuppofed  to  produce  this  difeafe.  In 
the  Amcenitates  Academiae,  there  is  a  curious  diflertation  on 
this  fubjed,  where  the  author  attempts  to  prove,  that 
living  fmall  animalculae,  lodged  in  the  inteftines,  are  the 
caufe  of  dyfentery; J  but  as  we  have  no  evidence  of  thefe, 
we  muft  confider  the  theory  as  merely  an  hypothefis,  or 
the  chimera  of  a  fanciful  imagination. 

*   Zimmerman  on  the  Dyfentery,  ch,  2. 

f  Pringle'sDifeafes  of  the  Army.  Monro's  Difeafes  of  the  Army,  3  iS. 

j  Amcenitates  Academiae,  vol.  v.  difTertt^a. 

PROGNOSIS. 


(      20      ) 


PROGNOSIS. 

THE  fymptoms  from  which  the  probable  event  of  dy. 
fentery  can  be  forefeen,  may  be  divided  into  thofe  which 
form  the  febrile  part  of  the  difeafe,  and  into  thofe  which 
conflitiite  the  ^eftion  of  the  inteftines. 

A  violent  fever  always  portends  danger,  from  the  effect 
it  has  on  the  fyflem  at  large;  and  it  may  caufe  the  local 
afFe6lion  of  the  inteftines  to  terminate  in  gangrene.  When 
the  difeafe  is  accompanied  with  much  debility,  and  want  of 
energy  in  the  fyftem,  as  manifefted  in  the  ftate  of  the  dif- 
ferent funftions,  it  evinces  great  danger;  and  the  danger  will 
be  in  proportion  to  the  degree  of  debility  which  prevails. 

A  tendency  to  putrefcence  in  the  fyftem,  is  an  index  of 
danger,  efpecially  when  petechias,  vibices,  &c,  appear  on 
the  ftirface  of  the  body,  aphthse  in  the  mouth  and  fauces, 
and  v/hen  the  tongue  has  a  black  appearance. 

It  can  hardly  be  faid,  that  dyfentery  is  in  any  ftage  with- 
out fymptoms  of  danger;  and  it  is  only  by  proper  remedies, 
timely  adminiftered,  that  the  difeafe  proves  to  have  a  fa- 
vourable termination. 

When  the  heat  of  the  body  is  not  conliderable,  the  thirft 
not  great,  the  ftools  copious,  and  not  very  frequent,  the 
fkin  moift,  the  urine  natural,  and  no  way  obftrufted,  it  is 
probable  that  the  difeafe  v/iii  end  favourably,  and  more  efpe- 
cially 


(  ^^  ) 

cially  if  the  foeces  become  more  natural,  if  there  is  a  deiire 
for  food,  and  if  the  pulfe  is  moderate. 

The  fymptoms  arifing  from  the  afFeftion  of  the  intef- 
tines  denoting  danger,  are  violent  tormina,  a  great  and 
frequent  defire  of  evacuating  the  contents  of  the  inteftines, 
without  that  effed,  and  an  inability  of  receiving  injedionf 
from  a  fpafmodic  afFe6lion  of  the  re6lum;  and  laftly,  the 
returning  of  injections  almoft  immediately  in  thofe  cafes 
where  they  could  be  received. 


METHOD  OF  CURE. 

DYSENTERY  is  a  difeafe  which  demands  the  particular 
attention  of  a  Phyfician.  Nature,  which,  on  many  occa- 
fions,  exerts  herfelf  to  cure  difeafes,  affords  but  little  relief 
in  this.  In  the  treatment  of  dyfentery,  fome  indications  of 
cure  are  pointed  out,  and  which  ought  to  be  purfued,  pay- 
ing attention  to  the  patient's  conftitution,  and  the  feafon  of 
the  year  in  which  the  difeafe  occurs.  Thefe  indications 
we  are  now  to  note. 

I.  To  evacuate  the  contents  of  the  flomach  and  intef- 
tines. 

3.  To  relieve  the  febrile  fymptoms,  and  to  alter  the 
determination  from  the  inteflines. 

3.  To  fupport  the  flrength  of  the  patient,  and  obviate 
the  tendency  to  putrefcence  in  the  fyllem ;  and, 

4.  To  diminiih  the  irritability  of  the  inteflines,  and 
reflore  their  tone. 

Such 


(  22  ) 

Such  is  the  importance  of  attending  to  the  firft  indica- 
tion, that  many  medicines,  which  have  the  power  to 
fulfil  it,  have  been  confidered  by  Phyficians  as  fpecifics 
in  the  cure  of  this  difeafe.  The  particular  njedicines  we 
come  next  to  confider. 

In  fome  cafes,  before  the  medicines  are  adminiftered 
to  fulfil  the  firfl  indication,  it  may  be  neceflary  to  take 
away  eight  or  ten  ounces  of  blood,  which  will  often  render 
the  purgative  and  emetic  medicines  more  fafe  and  efficar 
cious.*  But  it  muft  be  remarked,  that  blood-letting 
ihould  be  pra6tifed  with  caution,  as  the  tendency  of  dyfen- 
tery  is  to  produce  debility.  Dyfenteric  cafes  occuring  in 
the  fpring  or  beginning  of  fummer,  generally  bear  blood- 
letting better  than  thofe  which  occur  in  the  fall  or  latter 
end  of  fummer. 

Ipecacuanha  is  a  medicine  well  adapted  for  all  the  pur- 

pofes  of  ftiU  vomiting,  and  therefore  may  be  adminiftered 
with  advantage  in  dyfenteries  in  their  firft  ftages.  Given  in 
fmall  dofes,  it  is  alfo  purgative,  and  may  be  faid  to  favour 
a  determination  to  the  furface  of  the  body.  Such,  indeed, 
liave  been  the  good  effefts  of  ipecacuanha,  that  it  has 
been  confidered  by  Phyficians  as  a  fpecific;  but  from  what 
1  have  jufl  mentioned,  its  mode  of  operating  mufi:  be  ob- 
vious. , 

The 

*  The  cafes  in  which  blood-letting  appears  to  be  particularly  indicated 
are  thofe  in  which  the  pulfe  is  full,  hard  and  ftrong,  and  where  an  evident 
inflammatory  diathefis  appears  in  the  fyilem.  Sometimes,  however, 
where  the  pain  is  violent,  it  will  be  neceflary  to  bleed,  though  the  pulfe 
may  be  weak  and  contracted.  Do£lor  Monro  has  obf2rved,  that  in  fuch 
cafes  the  pulfe,  after  bleeding,  becomes  fuller  and  ftronger. 


(    23     ) 

'I'hc  chief  obje6lioA  to  the  ufe  of  ipecacuanha  is,  that  it 
is  very  apt  to  operate  as  an  emetic  when  given  in  fmall  dofes, 
and  by  that  means   prevent  our  obtaining  its   purgative 
efFefts,  which  are  mofl  required  to  evacuate  the  contents  of 
the  inteftines. 

The  preparations  of  antimony  are  now  preferred  to  every 
other  medicine  in  the  cure  of  this  difeafe;  and  of  the  various 
preparations  in  the  difpenfatories,  the  tartar-emetic  muft 
be  preferred.  In  tartar-emetic,  the  antimony  is  combined 
with  an  acid  which  renders  its  operation  more  certain  and 
a<Elive,  when  taken  into  the  flomach^  and  when  it  pafies 
into  the  inteftines,  more  efFe6lually  purgative:  for  this 
reafon  it  is  the  preparation  in  moft  common  ufe. 

Tartar-emetic  may  be  given  in  fuch  dofes  as  to  effeft 
full  vomiting  when  requifite,  or  it  may  be  adminiftered  in 
dofes  fo  as  to  prove  cathartic.  When  the  tartar-emetic  is 
intended  to  a6l  as  an  emetic,  it  fhould  be  given  in  large 
dofes,  and  at  fhort  intervals:  when  it  is  intended  to  a6l  as 
a  purgative,  it  fhould  be  given  at  long  intervals,  and  in 
fmall  dofes.  This  medicine,  belides  the  efFefts  juft  men- 
tioned, relaxes  the  fyftem,  and  determines  to  the  furface 
of  the  body :  hence  it  relieves  the  febrile  difpofition,  and  on 
this  account,  it  is  a  medicine  of  great  efficacy  in  the  cure 
of  this  complaint,  as  has  been  juftly  obferved  by  the  cele- 
brated Monfieur  Senac,  phylician  to  the  armies  of  France 
in  the  reign  of  Louis  the  fifteenth. 

The  other  antimonial  medicines  which  are  given  in 
dyfentery,   are  thofe  in  which  the  reguline  parts  are  un- 

combined 


(    24    ) 

combined  with  an  acid,  as  in  the  James's  powder,  and  glafs 
of  antimony.  The  James's  powder  proves  more  certainly 
purgative,  and  determines  more  to  the  /kin  than  the  tartar- 
emetic,  as  is  evident  from  the  nature  and  operation  of  the 
medicine.  The  glafs  of  antimony  has  been  commonly 
employed,  combined  with  wax ;  but  this  is  a  ufelefs  addi- 
tion, for  the  activity  and  value  of  the  medicine  depend  on 
its  meeting  with  an  acid  in  the  ftomach,  and  there  form- 
ing a  kind  of  tartar-emetic :  but  as  this  is  the  worft  prepa- 
ration of  antimony,  it  is  how  feldom  employed. 

When  emetic  medicines  are  given,  fmall  quantities  of  an 
infuiion  of  camomile  flowers  fhould  be  drank  occafion- 
ally  after  the  vomiting  has  been  produced,  to  prevent  painful 

fpafmodic  afFeftions  of  the  ftomach. 

The  next  clafs  of  medicines  which  may  be  ufed  to  eva!- 
cuate  the  contents  of  the  inteftines,  and  which  we  now 
come  to  notice,  are  thofe  called  more  ftriftly  purgative. 
Of  thefe,  the  neutral  falts  are  thofe  moft  commonly  em- 
ployed, fuch  as  Glauber's  falts,  Epfom's  falts,  and  chryftals 
of  tartar.  The  falts  ftiould  be  diflblved  in  a  fuflicient 
quantity  of  water,  and  given  in  divided  dofes,  until  free 
difcharges  are  produced.  The  falts  may  alfo  be  combined 
with  fome  other  medicines.  Doctor  Monro  highly  re- 
com.mends  a  combination  of  falts,  manna  and  oil;*  but  the 
moft  ufeful  combination  to  the  two  firft  of  thefe  medicines 
is  that  of  an  antimonial:  thus,  Glauber's  falts,  manna  and 
tartar-emetic,  combined  in  folution,    make  a  convenient 

and 

*  Monro's  Difsafes  of  the  Army, 


aftd  efficacious  mixture,  which  may  be  given  in  divided 
dbfes^  until  the  patient  have  free  difeharges,  and  is  relieved 
fi-otri  thfe  tormina  or  griping  pains. 

"Gaftof  oil,*  tamarinds  in  decoction,  and  medicines  of  this 
nature,  have  alfo  been  ufed  with  fiiccefs.f  Rheubarb,  jalap 
and  aloes  arfe"  the  leaft  proper  purgatives :  when  given  ia 
powder,  they  are  apt  to  produce  too  great  irritation;  com- 
bined with  fpiritSj  in  the  form  of  tinftures,  they  are  equally 
obje6lionable :  for  th'efe  reafons  they  are  not  ufed  by  the  mofi: 
Ikilful  practitioners  at  the  prefent  day. 

Under  the  head  of  purgatives,  muft  alfo  be  confidered 
iiijeCtions  thrown  into  the  inteltines.  Animal  broths,  mild 
mucilaginous  mixtures  of  flarch  or  gum-arabic,  are  the  moft 
j5roper:  thefe  lllould  be  inje6ted  in  confiderable  quantities, 
With  the  occafional  addition  of  caftor  or  common  oil;  and 
When  there  is  much  pain,  inje6tions  may  be  ufed  combined 
with  laudanum,  or  a  folution  of  opium. +  Thefe  are  alfo 
highly  proper  to  relieve  the  tenefmus,  which  is  often  one  of 
the  moft  troublefome  fymptoms.  Anodyne  injections  have 
likewife  a  gOod  eifeCt  in  preventing  the  prolapfus  ani ;  but 
when  this  oc-curs,  if  ihould  be  remedied  by  aftringent  appli- 
cations, combined  with  fomething  of  an  anodyne  nature. 
When  the  topical  aiFeCtion  is  very  great,  and  there  appear^ 
D  danger 

*  Caftor  oil  is  frequently  naufeous  to  patients,  and  will  fometlmea 
occafion  vomiting}  to  prevent  which,  a  fmall  quantity  of  fpirits  of  laven- 
der may  be  added. 

-}-  Under  this  head  muft  be  referred  mutton  fuet  and  animal  broths, 
which  have  all  a  laxative  effedl:. 

J  In  throwing  in  injedions,  great  care  fhould  be  taken  that  it  be  done 
in  a  gradual  and  eafy  manner,  for,  if  not,  they  may  have  a  tendency  to 
increafe  the  irritability  of  the  parts,  and  confequently  the  difeafe. 


(       26       ) 

danger  of  gangrene,  injedions  of  the  infulion  or  decoclroa 

of  the  Perjvlan  bark,  finely  filtered,  fhould  be  ufed  every 
three  or  four  hours,  or  according  as  the  cafe  may  require. 

The  efFefts  of  the  medicines  which  we  have  juft  men- 
tioned, are  commonly  fuch  as  not  only  relieve  the  topical 
complaints  of  the  ftomach  and  inteflines,  and  evacuate  their 
contents,  but  alfo  diminifii  very  much  the  febrile  fymptomsj 
for  this  reafon  they  fhould  be  occafionally  continued 
throughout  the  treatment  of  the  difeafe. 

The  fecond  indication  of  cure  which  I  have  given,  and 
to  which  we  fhall  now  attend,  is  that  of  relieving  the  febrile 
fymptoms  and  altering  the  determination  from  the  inteflines. 

The  febrile  fymptoms  are  to  be  treated  according  to  their 
nature,  as  they  are  attended  with  more  or  lefs  excitement  in 
the  fyftem.  In  mofl  cafes  it  will  be  requifite  to  employ  the 
antiphlogiftic  regimen,  excepting  the  application  of  cold, 
which,  by  obflru fling  the  determination  to  the  furface  of  the 
body,  may  be  injurious.  The  tenfion  of  the  arterial  fyflem 
may  be  much  diminifhed  by  thofe  means  mentioned  to  fulfil 
the  firft  indication ;  ancf  as  part  of  the  proximate  caufe  of  the 
difeafe  is  that  of  the  fever,  antimonial  and  other  remedies 
which  are  difpofed  to  determine  to  the  furface,  fhould  be 
employed  as  circumfiances  may  direfl. 

In  the  courfe  of  the  fever,  when  the  inteflines  have  been 
fully  difcharged,  it  may,  in  many  cafes,  be  necefTary  to  at- 
tend more  particularly  to  the  cure  of  the  difeafe,  when  fli- 

mulants 


(    ^7    ) 

mulants  and  tonics  may  be  ufed,  fuch  as  good  wine  and  the 
befl  Peruvian  bark.  Wine  may  be  given  in  any  form  that 
may  be  agreeable  to  the  patient;  but  it  requires  feme  cir- 
.cumfpe£lion  in  adminiftering  the  bark,  which  ought  never 
to  be  given  in  fubllance  where  the  flomach  or  inteftines  are 
difeafed,  as  the  powdered  bark,  however  finely  prepared, 
may  produce  irritation  from  its  mechanical  action.  The 
mofl  proper  preparation  of  the  bark  is  the  cold  infufion, 
made  with  magnefia,  and  finely  filtered. 

In  thofe  cafes  of  dyfentery  in  which  the  fever  puts  on  a 
remittent  or  intermittent  form,  it  is  very  necelTary  to  be 
more  free  in  the  ufe  of  the  infufion  of  the  bark,  to  prevent 
the  return  of  the  paroxyfm.*  Where  l-his  treatment  has 
been  purfued,  the  good  effects  which  have  refulted  juflify 
its  propriety. 

The  tendency  of  fevers,  in  dyfentery,  to  thofe  of  a  typhus 
nature,  and  the  tendency  of  the  fyflem  to  putrefcence,  are 
to  be  obviated  by  due  attention  to  cleanlinefs,  as  changing 
frequently  the  bed-clothes  and  body-linen  of  the  fick.  The 
air  of  the  patient's  apartment  Ihould  be  particularly  attended 
to;  free  ventilation  fhould  be  ufed,  and  if  this  cannot  be 
properly  performed,  branches  of  trees  or  fhruLs  may  be 
placed  in  the  room  during  the  day  with  good  efFeft,  as  they 
abforb  the  mephitic  air  and  emit  what  is  pure.  The  air  of  the 
apartment  may  likewife  be  rendered  purer,  or  at  leail  more 
agreeable,  by  having  the  floor  fprinkled  with  vinegar,  or  hav- 
ing different  aromatic  fubflances  burnt  in  the  room.     Great 

care 

*  Cleghorn'sDifeafes  of  Minorca,  and  Llnd  on  thofe  of  Warm  Climates. 


care  fhould  be  taken  that  all  excrementitious  matters  be  re* 
moved  as  foon  as  poffible,  for  they  are  the  chief  fource  of 

the  impurity  of  the  air. 

Determining  to  the  fiirface  of  the  body  in  fevers,  is  Ayell 
calculated  to  take  off  the  fpafpri  from  the  extreme  vefTels, 
which  conftitutes  a  part  of  their  proximate  caufe.  But,  in 
the  cure  of  dyfentery,  it  i^  of  very  great  confequence  to  re- 
lieve the  local  affeftion  of  the  inteftines.  For  this  purpofe, 
the  furface  of  the  body  fhould  be  kept  warm  when  antimo- 
nial  medicines  are  adminillered,  to  caufe  them  to  de1;ern:;ine 
to  the  furface,  while  at  the  fame  time  they  may  evacuate  the 
contents  of  the  ftomachand  intellines.  Small  dofes  of  lau- 
danum m.ay  be  added  to  the  antimonial  medicines  afterproper 
evacuations,  to  favour  their  operation  in  determining  to  the 
furface.  Upon  the  fame  principle,  bliftering  and  warm  bath? 
ing  or  fomentations  to  the  abdomen,  may  be  employed, 
efpecially  when  the  local  affe.clion  is  any  way  confiderable, 
and  attended  with  violent  pain.  Dodor  Moseley,  in  his 
Trealife  on  Tropical  pifeafes  and  on  the  Climate  of  the 
Weft-Indies,  fully  illuftrates  this  practice ;*.  a;id  othe^. 
writers  of  eminence  juftify  the  fame  opinion,  w.hich,  indeed, 
feems  confonant  to  reafon  and  the  nature  of  the  difeafq. 


The  third  indication  which  I  have  mentioned,,  and  to 
hich  we  come  now  to  pay  our  attention,  is  to  fupport  the 
frrength  of  the  patient,  and  obviate  the  tendency  to  putre- 
fcence  in  the  fyflem. 


w 


Contagion? 


(    29    ) 

Contagious  difeafes  of  all  kinds  have  a  great  eflfed  Qt\ 
the  nervpus  fyftem,  in  inducing  a  ftate  of  debility j  bu| 
this,  is  particularly  the  cafe  with  that  which  produces  dyt 
fentery:  therefore,  fuch  medicine  and  diet  fliould  be  admi- 
niilered,  as  may  bed  tend  to  obviate 'the'eifefts  of  the  con- 
tagion. Wine,  in  proper  quantities,  good  animal  broths^ 
and  the  Peruvian  bark,  are  befl  calculated  for  this  purpofe. 
When  broth  is  employed,  care .  fliould  be  taken  that  all  the 
tat  is  removed.  Salep  and  fago  may  alfo  be  given,  accord-^ 
ing  to  circumftances :  they  form,  with  water,  a  pleafant: 
mucilaginous  drink,  well  adapted  to  perfons  labouring  un- 
der this  complaint.  R.ipe  fruits  of  ail  kinds,,  but  efpec.ialljf 
thofe  of  a  fub-acid  nature,  may  likewife  be  given:  tiiejr 
have  been  known  to  be  of  great  fervice  in  obflinate  cafes 
9^  the  difeafe,  where  other  remedies  had  been  ufed  without 

•  It  is  unnecefTary  to  repeat  the  directions  already  propofed 
t©  obviate  the  tendency  to  putrefcence  in  this  complaint, 
a^  the  m.eans  have  been  mentioned  in  the  treatment  requifite 
^  jfelieve  the?  febjrile  fy mptoms. 

The  fourth  and  lafl  indication  which  I  have  given,  and 
l^hich  vt/e  come  now  to  coniider,  is  that  of  diminifhing  the 
yfritability  of  the  inteilines,  and  reiloring  their  tone. 

Every  part  of  the  human  body  becomes  much  more 
irritable  when  inflamed ;    and  this  is  efpecially  the  cafe  in 

the 


*  Zimmerman  on  Dyfentery,    Prlngle's  Difeafes  of  the  Army.    Mon- 
ro's  Difeafes  of  tiie  Army. 


(     30     ) 

the  inteftines,  where  there  are  a  confiderable  number  of 
nervous  papillse.  To  obviate  an  h'ritable  flate  of  the  intef- 
tines, is  of  much  confequence  in  the  cure  of  dyfentery. 

To  obtain  this  object,  we  make  ufe  of  mucilaginous  and 
anodyne  medicines, 

Gum  tragacanthj  in  the  form  of  mucilage,  is  laid  to 
allay  the  irritation  of  the  inteftines;  but  perhaps  it  does 
it  only  in  an  indirect  way,  namely,  by  flieathing  the 
coats  of  the  inteftines,  and  preventing  their  being  irritated 
by  the  acrimony  which  is  frequently  generated  in  them. 
Gum-arabic,  ftarch,  and  flour  long  boiled  and  formed 
into  mucilages,  have  the  fame  good  effeil.  But  the  moft 
ufeful  medicines  for  this  purpofe,  are  opiates,  given  in 
fome  form  or  other;  fometimes  combined  with  aromatics 
and  aftringents,  and  at  other  times  not.  The  forms  in 
which  it  is  combined  with  aromatics,  are  the  theriacs  of 
the  difpenfatories :  thofe  in  which  aftringents  are  combined, 
are  the  compound  powder  of  bole,  and  the  fpecies  aromaticae, 
&c.  Thefe  preparations  have  at  times  good  effects ;  but 
in  the  beginning  of  the  difeafe  care  ought  to  be  taken  not 
to  adminifter  medicines  which  will  counteract  the  full  dif- 
charge  from  the  inteftines;  and  therefore,  M^hen  opiates  arc 
employed  internally,  they  are  fafeft  when  combined  with 
ipecacuanha  or  tartar-emetic.  In  this  v\'ay  their  bad  effefb 
on  the  different  fecretions  are  prevented.  They  may  be 
alfo  combmed  with  calomel 

Opiates 


(     31     ) 

Opiates  may  alfo  be  employed  externally,  either  in  th« 
form  of  a  plaifter  to  the  abdomen,  or  in  fomentations.  For 
this  lafl  purpofe,  the  heads  of  poppy  may  be  ufcd  to  make 
a  ftrong  decoftion,  and  this  deco6lion  applied  in  the  form 
of  a  fomentation,  three  or  four  times  a  day,  to  the  abdomen, 
for  the  fpace  of  one  or  two  hours. 

A  temperate  atmofphere  fhould  always  be  obtained  if 
poffible;  cold  fliould  be  avoided,  as  it  is  apt  to  caufe  a  con- 
tinuance of  the  difeafe,  from  its  producing  a  determination 
to  the  inteftines,  and  often  counteracting  the  moft  powerful 
remedies  which  can  be  employed.  The  patient's  cloathing 
mufl  be  of  a  warm  kind;  perhaps  wearing  flannel  next  to 
the  fkin  would  be  the  beft  means  of  keeping  up  a  conflant 
determination  to  the  furface  of  the  body,  and  of  prevent- 
ing, in  a  great  meafure,  the  bad  effefts  which  might  arife 
from  any  fudden  viciffitude  of  weather  to  which  the  patient 
may  be  expofed. 

Aftringent  and  anodyne  medicines  may  alfo  be  ufed  to 
reftrain  the  difcharges  from  the  inteftines.  The  confedio 
japonica  of  the  New  Edinburgh  Difpenfatory,  is  a  very 
proper  and  ufeful  compofition,  as  it  contains  fome  of  the 
more  powerful  aflringents  combined  with  aromatics,  as  the 
gum  kino  and  fuccus  japonicus.  The  cortex  granatorum, 
querci,  lignum  campechence  and  its  extraft,  rad.  Colombo 
alumen,  and  other  aftringents,  may  be  alfo  ufed  with  ad- 
vantage. The  fimarouba  bark  has  likewife  been  confidered 
as  very  efficacious,  and  has  been  ufed  by  feveral  phyficians; 
but  others  confider  it  of  very  little  efficacy;  though  it  is 

faid 


(     3^     ) 

laid  to  have  fucceeded  in  fome  very  obftinate  cafes,  wh'efe 
more  powerful  aftringents  had  failed. 

'  It  only  remains  for  me  now  to  mention  the  meafis  to  be 
employed  by  convalefcents  after  the  difeafe,  and  the  means 
to  prevent  the  fpreading  of  the  contagion.  With  regard  to 
the  firll,  due  attention  fhould  be  paid  to  regimen,  diet  and 
exercife;  and  with  refpeft  to  the  fecond,  the  moft  proper 
means  to  obviate  the  effects  of  the  contagion,  is  to  avoid 
thofe  caufes  which  we  have  marked  as  predifpoling  th^ 
llabit  to  this  complaint,  and  to  avoid  the  occalional  or  ex- 
citing caufe. 

The  limits  to  which  a  difTertation  of  this  kind  is  ufually 
confined,  Torbid  my  enlarging  furthef  On  the  fubjef^. 


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